Video Game Improves Balance in Youth With Autism

Playing a video game that rewards participants for holding various “ninja” poses could help children and youth with autism spectrum disorder (ASD) improve their balance, according to a recent study in the Journal of Autism and Developmental Disorders led by researchers at the University of Wisconsin (UW)-Madison.

Balance challenges are more common among people with ASD compared with the broader population, according to study lead author Brittany Travers, PhD, and difficulties with balance and postural stability are commonly thought to relate to more severe ASD symptoms and impaired activities in daily living.

“We think this video game-based training could be a unique way to help individuals with ASD who have challenges with their balance address these issues,” says Travers, an investigator at UW-Madison’s Waisman Center and an assistant professor of kinesiology.

In this pilot study—the largest ever to look at the effects of balance training on individuals with ASD—29 participants aged 7­–17 with ASD completed a six-week training program playing a video game developed by the researchers.

By the end of the program, study participants showed significant improvements in not only their in-game poses but also their balance and posture outside of the game environment.

According to Travers, balance improvements outside the video game context are especially important. “Our participants are incredibly clever when it comes to finding ways to beat video games!” she says. “We wanted to make sure that the improvements we were seeing were truly balance-related and not limited to the video game.”

Ten out of 11 study participants who completed a postgame questionnaire also said they enjoyed playing the video games.

“We always aim to make the interventions fun,” Travers says. “We have couched a rigorous exercise (by the end of some gaming sessions, participants had been standing on one foot for 30 minutes) in a video game format, so we were delighted to hear that the participants enjoyed the game.”

The gaming system uses a Microsoft Kinect camera and a Nintendo Wii balance board connected to software developed on a Windows platform using Adobe Air.

“Players see themselves on the screen doing different 'ninja' poses and postures, and they are rewarded for doing those poses and postures; that's how they advance in the game,” Travers says.

The study also explored individual differences that might predict who would benefit most from this type of video game-based balance training.

For example, the study showed that participants with some characteristics, such as ritualistic behaviors (such as the need to follow a set routine around mealtimes or bedtime) did not benefit as much from the video game as those without these behaviors.

On the other hand, some characteristics, such as body mass index or IQ, did not influence whether a participant benefited from balance training.

“There is a lot of variability in the clinical profile of ASD, and it's unlikely that there will be a one-size-fits-all approach for balance training that helps all individuals with ASD,” Travers says.

Researchers are working to make the game more accessible to different individuals within the autism spectrum. “We already have some features that help—the game has very little verbal instruction, which should make it more accessible to individuals who are minimally verbal,” Travers says. “Ultimately, we would like to move this video game-based training outside the lab.”

In findings presented to the American Society of Hematology, Mayo Clinic researchers found that using emojis instead of traditional emotional scales were helpful in assessing patients’ physical, emotional, and overall quality of life. Researchers found that using iPhones and Apple Watches were favored by patients, and the technology helped collect study data accurately and efficiently. The study, created using Apple’s ResearchKit framework, showed that Apple Watch provides objective, continuous activity data that correlate with established cancer patient-reported outcomes.

“Cancer patients receive complex medical care, including surgery, radiation, chemotherapy, and targeted agents that may result in physical, emotional, financial, and spiritual consequences that can negatively impact quality of life and the ability to perform certain activities without help,” says lead author Carrie Thompson, MD, a hematologist at Mayo Clinic. “These quality-of-life factors play an important role in predicting survival and determining the best treatment options.”

Thompson says gauging a patient’s qualify of life and performance status can be challenging, because it typically involves completing lengthy paper questionnaires, which can be burdensome for patients and may be inaccurate. “In our study, we wanted to determine whether wearable technology data could be correlated with traditional, validated patient-reported outcome measures in cancer patients," Thompson says.

Researchers recruited 115 patients with lymphoma and multiple myeloma at Mayo Clinic with expected life spans of less than five years and who owned an iPhone 5 or later. All patients were provided with an Apple Watch and downloaded a study app at enrollment. Researchers collected baseline data, including questions regarding physical function, fatigue, sleep, social role, function, and quality of life.

In addition, researchers developed two electronic emoji scales to measure quality of life.

“Emojis are a near-universal, popular form of communication, understandable by diverse populations, including those with low health literacy,” Thompson says. “There are several studies that attempt to predict individual well-being based on analysis of social media postings on Facebook and Twitter, but these studies do not focus on emojis as a mechanism for patients to express how they are feeling on a given day. If we can demonstrate that simple emojis are a valid and reliable measure of patient well-being, it could transform the way patient well-being assessments are accomplished.”

During the first week of the study, patients wore their Apple Watch for an average of 9.3 hours per day, took 3,760 mean steps per day, exercised 8.3 minutes per day, were sedentary 224.9 minutes per day, and burned 115.8 kcal per day. Researchers observed significant associations between standard patient-reported outcome measures and activity data. The strongest correlation was between steps per day and the Patient-Reported Outcomes Measurement Information System physical function scoring system. In addition, researchers found that patients’ emoji responses were significantly associated with standard patient-reported outcomes.

“While further research is needed to validate the use of wearable activity monitors in cancer care, we believe this technology has the potential to improve the way we care for patients,” Thompson says. “In the future, it may be possible to monitor patient symptoms and communicate with patients between appointments via wearable technology.”